IPU

We walked into the In-Patient Unit, not knowing what to expect yet at the same time looking around in eager anticipation. Today was the day we would have direct contact with those people most affected by the AIDS pandemic in and around Rustenburg, those people that were at their lowest points and thus needed the most help. Tapologo’s IPU is essentially made up of three wards, a ward for male patients which lies adjacent to the female ward in the main IPU building. A stone’s throw away is the TB ward where patients with tuberculosis are quarantined to prevent TB infection of the other patients.
After a brief introduction given by Bernard, one of the nurses on duty for the day, we began our day just talking to the patients and as Bernard says, trying to establish if there are any social disorders they should address. We walked into the male ward where 4 patients all turned and glanced over at us as we stood awkwardly waiting for a cue or direction from Bernard. “Bo ausi ba ba tlo bua le lona ba le bolelele gore ke bone bo mang” he said (these ladies are just here to chat with you and tell you who they are and find out how you’re doing). I immediately felt the same anxiety that I felt that third week of march when we first arrived and were told to talk to the patients at Freedom Park. In my mind I wondered what exactly I would say to the 4 men in the IPU without being intrusive and asking them about their condition. My ability to speak Setswana put me at an advantage so I sat next to the bed closest to the door. The patient in the bed lay tilted up with his thin frame straight down the middle of his bed. The lower half of his legs were as thin as my arms but what startled me the most was the colour of his finger nails, the nail bed was a dark grey colour that I had never seen before but was told by Bernard that it was very common among HIV positive patients. I sat and listened as the male patient told me about where he was from and how he hoped to get better soon so he could go back to working in the mine. In the back of my mind I wondered if he would ever be strong enough to return to work, especially the tedious and laborious tasks required in the mines but I realised that for him it was something to look forward to. He spoke so passionately about how he studied engineering and what he did at the mines that I realised that looking forward to his work was the only hope he had of claiming back his old life, the only thing that would signify recovery and strength. I sat and listen to the zeal in his voice as he spoke about the future and watched the glow in his eyes as he said how he hoped to be discharged today, in the back of my mind, wondering if it was all going to be possible but hopeful for him.
We moved on to the TB ward, only after getting face masks from Bernard that resembled the beak of a duck when we put them on. Despite the mask fitting tightly around my nose and mouth I could still smell the faint scent of disinfectant that always lingers around in hospital settings, there again we spoke to the two female patients that were alone in the TB ward. Treatment for tuberculosis is taken for 9 months and because many of the patients are said to be ‘defaulters’ meaning that they stop taking medication once they see signs of recovery, Tapologo requests that the patients stay for the entire 9 month period to ensure that they take all of their medication as is required. One patient had not been taking her ARV’s or her TB medication and as a result her belly had swollen up so much that it resembled that of a pregnant woman at 9 months gestation. She explained to us that when the resident doctor at the IPU comes in he usually drains the fluid from her swollen abdomen and that just a few days ago he had drained 10 litres of fluid. She pulled back the sheets from her bed to show us her belly and explained the excruciating pain that comes with the fluid drainage. She later got up from her bed to watch TV in the other room and we went and sat down with some off the support staff at Tapologo for a cup of tea.
It had already felt like a long morning, not because of the time that we had spent there but mainly because of the things we had seen and the conversations we had had. When we approached Bernard again after tea he told us that he had to deliver some bad news to a family because a patient had just died. The patient was HIV positive, had had TB AND had cancer as well, way too much for one person to handle I thought. I listened in as Bernard make the call, “ausi, ke le tshwaretse dikgang tse di botlhoko” (I have some terrible news for you) he continued in Setswana as Lily and I stood behind the counter watching him closely. He explained that the patient had died and that because Tapologo did not have a morgue on site, the family needed to confirm which funeral home they should call to come and collect the body. We had not seen this particular patient because they were kept in seclusion due to their weaker condition in comparison to the other patients, I could not put a face to the name but in my mind I kept thinking that ‘someone had died today.’
By lunch time I felt weak myself, physically and mentally and Bernard looked at us and declared that we could help with feeding the patients and then should go home until tomorrow. We obliged and after feeding, as we washed the dishes before heading out for the day, I started talking to the nurse that had walked in to find the patient that had passed away. She explained how she closed the patient’s eyes and mouth and changed them out of the hospice clothes into their own clothes. She explained how she cleans the patient and covers them as they wait for the funeral home to come and take them away. “Maybe I should have called you to come and help me clean the patient” she said, I replied that she should have but still am not sure how I would have reacted to that experience, “you get used to it,” she said.